The Clinic

It's early morning at Bairo Pite clinic in the suburbs of Dili, East Timor and there are already hundreds of patients waiting to see Dr Dan Murphy. The former GP from America's Midwest came to the country 16 years ago with just one little bag and has been here ever since. During that time he's managed to make an incredible difference with very few resources.

"There is really no access to anything near adequate healthcare. In every category in health, their numbers are worse than most of South East Asia. We don't have very many meds. We don't have very many diagnostic tools so mostly we're going by smoke and mirrors. You can't do as well as you could if you had all the right tests." DR DAN MURPHY, Medical Director Bairo Pite Clinic

While Australia and East Timor continue to wrangle over who owns the rights to billions of dollars worth of oil and gas in the Timor Sea, the standard of living here continues to plod. According to a UN report last year 68% of the population still lives in poverty, 38 per cent in severe poverty.

Dr Dan and his team have become experts in diseases most Australian's thought has been consigned to history. When five-year-old Paulo walks in with strange marks on his arms and face, Dr Dan knew Leprosy might be on the cards. He's already seen 7 cases in the past month. Meanwhile, there is a ward full of tuberculosis patients and another packed with malnourished children. We meet four-year-old Ozmenia who's four years old, but only weighs 6.7 kilos.

"Certain times of the year there's just not much to eat. Approximately half of the people are stunted which means they're not as big as they should be for their age." DR DAN MURPHY, - Medical Director Bairo Pite Clinic

Meanwhile, up in the mountains of the Ermera District, women have walked for hours to see Dr Aida Goncalves and her team of midwives. East Timor has one of the highest rates of maternal mortality in Asia and Dr Goncalves does her best to convince women seek out help when giving birth. Her motivations make a difference to these people's lives is driven by tragedy close to home - three brothers lost to preventable illness.

"Two of my brothers they died of diarrhoea. Something in your country that doesn't kill people, but here in Timor it kills a lot of people. My other brother died from asthma at 17." DR AIDA GONCALVES, Frontline NGO.

Back in Dili, 34-year-old father of three Tomas Pinto is dangerously ill and could die at any moment. Like many East Timorese, he had rheumatic fever when he was younger, a common illness here that can lead to lifelong heart trouble. In Australia, a simple operation would fix the valve in his heart that has become dangerously narrow, however this is just one of the many operations not available in East Timor. He can't believe his luck when a lifeline from Australia is suddenly extended to him.

"I was the one person out of so many that God chose, from so many people. I'm just from a poor family. And was chosen from so many Timorese. I am so very grateful." TOMAS PINTO, Maths teacher and heart patient.

From a frantically busy clinic in Dili to the lush mountains districts to a Melbourne cardiac ward, in her debut report for Foreign Correspondent, Sophie McNeill follows the inspiring doctors and patients caught in the middle of this crisis. Reporter: Sophie McNeill Producer: Ian Altschwager Camera: Ron Ekkel Editor: Garth Thomas __________________________________

Transcript

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MCNEILL: Pretty much everything moves slowly in this languid little place on Australia's doorstep. As morning unfolds, people gradually make their way into the early light and their day ahead. It's all very unrushed - unless you're on a motorbike and you're heading into the mayhem of Dili's Bairo Pite Clinic. Here it's action stations and American Dr Dan Murphy is off and running on his relentless rounds.

DR DAN MURPHY: "There is really no access to anything near adequate healthcare. In every category in health, their numbers are worse than most of South East Asia".

MCNEILL: One man and his small team of volunteers, taking on a case list that would overwhelm many medical professionals.

DR DAN MURPHY: [asking mother of a young girl] "Does she speak to you?"

MCNEILL: To the south, Australia and it's internationally recognised healthcare. Dr Dan is in the thick of arguably the biggest health crisis in our region, but his clinic and Dili's main government run hospital have precious little money, medicine or technology to deal with it.

DR DAN MURPHY: "There's very few things we can do. We don't have very many meds, we don't have very many diagnostic tools, so mostly we're going by smoke and mirrors and trying to make a good lucky guess and hope that people get better. But you can't do as well as if you had all the right tests".

[in ward] "You can see he's down to almost no weight. I think he's 20 kilos or something. It could be something that were he in a more developed country he could be cured. It's very sad".

MCNEILL: Across town, year ten students at Dili's largest high school are settling into class. Out front is teacher Tomas Pinto.

TOMAS PINTO: [to the class] "I join these lines together. How does that look?"

MCNEILL: In many ways the challenges facing Tomas in this school are similar to those confronting Dr Dan at his clinic. Scant resources and a massive task, preparing these kids for a challenging world. And if that wasn't difficult enough, Tomas is dangerously ill. When he was younger he had rheumatic fever, a common illness in East Timor that can lead to life-long heart trouble.Tomas first started feeling sick about a year and a half go.

TOMAS PINTO: "My family noticed it. I hadn't really thought of it myself - but then others noticed, and they started saying "Hey, why are you like this?" And so I knew I needed to see a doctor. I don't have strength. Sometimes, I can't catch my breath. Sometimes I get dizzy - sometimes I just black out".

DR DAN MURPHY: "Tomas Pinto could die at any moment. His heart is that bad".

TOMAS PINTO: "What are we eating?"

TOMAS PINTO'S WIFE: "Only vegetables".

TOMAS PINTO: "Ok, I'm going to wash my hands".

TOMAS PINTO'S WIFE: "Please follow your father to wash your hands".

DR DAN MURPHY: "He has mitral stenosis which is one of the big curses of the tropics and this valve get smaller and smaller and smaller and pretty you soon you know you get a stroke or you die".

MCNEILL: There's quite a simple procedure that would fix Tomas' heart but specialist cardiac surgery is just one of the many kinds of operations not available in East Timor.

TOMAS PINTO: "There are many parts so far underdeveloped - resources and government areas of specialisation such as heart operations, for example. We don't yet have our own heart specialists".

MCNEILL: Tomas' best chances lie overseas but a modest teacher's salary in Dili doesn't get you to a foreign hospital and his hope of moving up the long government waiting list for international care isn't great. All he can do is wait and pray.

This isn't the only place to get treated in town but it's certainly the busiest. Among the hundreds of people seeking diagnosis and treatment every day at Dan Murphy's clinic, there'll be those like Tomas Pinto who can't be helped - and then there'll be those whose illness would shock and confound a big city casualty department. That's when this doctor and his team come into their own.

NURSE: "So when you feel the pen press, show me where it is. Straight away, OK? And if you feel it somewhere else, show me but keep your eyes closed. Understand?" [touches pen onto arm and in a couple of spots child cannot feel it]

MCNEILL: East Timor has the highest rate of leprosy in South East Asia. It's a disease that's completely treatable and utterly preventable.

DR DAN MURPHY: "We still see it and in fact in the last month I think I've seen seven cases, though the district of Oecusse has over 500 registered cases".

MCNEILL: About the only things Dr Dan holds onto from his past as a GP in America's mid-west is his accent and his love of basketball. He'd worked in other disadvantaged parts of the world when East Timor caught his eye. He saw a need, packed his bags and left Iowa. That was 16 years ago.

DR DAN MURPHY: "I mean it's not just the practice in Iowa, it's also how does one go about extricating themselves from the middle class. So I found ways of just slash and burn, get rid of everything".

MCNEILL: "You literally just sold everything and moved to Timor?"

DR DAN MURPHY: "Came with one little bag. Yeah".

MCNEILL: After Indonesia relinquished its control, substantial aid began to roll in here. In recent years, proceeds from oil and gas mean there's more money in East Timor than there's ever been. Yet according to the UN, two thirds still live in poverty - a third in severe poverty. There's still billions of dollar's worth of unexploited resources sitting in the Timor Sea, but as Australia and East Timor continue to wrangle over who owns the oil fields, these extra billions remain in the seabed.

DR DAN MURPHY: "East Timor has never had a chance to develop like the rim of Asia. East Timor has never been given an opportunity. They were a colonial, part of the colonial empire of Portugal for 500 years and then a brutal military occupation by Indonesia for 24 years that knocked everything else out".

MCNEILL: East Timor has some of the worst malnutrition rates outside of Africa. Nearly 45% of children under 5 are classified as underweight. The clinic runs a busy inpatient ward, dedicated to treating undernourished kids.

Four year old Ozmenia arrived weighing just 6.7 kilos. She just keeps getting diarrhoea and being readmitted.

"Ozmenia is actually four years old".

NURSE: "Yeah she's four years old".

MCNEILL: "And why is she so malnourished?"

NURSE: "Okay she's malnourished because the mum has lots of children and they are really poor. They live in the mountains and it's really hard for them to get the water - they have to go down and get the water. It means they don't really have like good hygiene".

MCNEILL: "Lydia and Sylvia, the carers in charge of this ward, do everything they can to make eating enjoyable. Their efforts pay off. These five month old twins arrived weighing only 2 kilos each.

MCNEILL: "So the babies have more than doubled their weight in the past six weeks".

SYLVIA: "Yes".

MCNEILL: "It's a success story here in the malnutrition room".

SYLVIA: "Yes of course - and I'm very happy".

MCNEILL: For schoolteacher Tomas Pinto, faith and prayer have finally paid off. An Australian charity called "East Timor Heart Fund" will pay for him to fly to Melbourne and undergo life-saving surgery.

TOMAS PINTO: "I am so very grateful. When I go to have the operation, I will be offering myself to God and to my doctors, and trusting they will look after me".

DR DAN MURPHY: "We are so fortunate to have a group in Australia who have found ways to give state of the art care to poor Timorese people, free. It's amazing. And actually, to tell you the truth, Australians in general I have found to be most generous people".

MCNEILL: Tomas Pinto had never flown before and certainly never experienced the sort of cold Melbourne's turned on for his arrival. Members of the local East Timorese community are there to meet him.

TOMAS PINTO: "It is the first time that I have travelled outside my country... so yes I feel happy!"

MCNEILL: Tomas is on his way to the cardiac unit at Monash Medical Centre and while the patient heads to the expertise here, in East Timor, the expertise is heading out to the patients. Most of East Timor's population live outside the capital, in regional towns and tiny villages scattered across the island.

[riding in car] "Now we're out of Dili, we're on some really remote and rough roads here in the mountains of East Timor and we're going to one of the Bairo Pite Clinic's remote visits. Now where we're heading the people there might only get to see a nurse or a midwife once a month if they're lucky so there could be dozens of people waiting for us when we get there".

MCNEILL: We're following Aida Goncalves who's based out of Bairo Pite Clinic. She's a piece of paper away from her medical degree and is one of the country's most experienced obstetric specialists.

DR AIDA GONCALVES: "I've been doing this for six years and every time I come out here I always get inspired because you know you never know what you.... you know, you might find out in the villages".

MCNEILL: On these roads you never know if you're going to get there safely.

DR AIDA GONCALVES: "Oh Jesus... Oh Saint Anthony... Oh Saint God's Mother.. Yes I think we should get out of the car. Wait! Get out! Okay get, get out of the car".

MCNEILL: This bridge is missing a few wooden planks and the back wheel is nearly hanging off the side.

DR AIDA GONCALVES: "Sabino, you have to get out of the car. Come and have a look. Stop. Stop! Don't drive! You could come and see from the front, here! See how fun this is? This is what we do. [Sabino gets car across the bridge] Yeah, yeah!!! Hallelujah!! [laughing] All right. So you almost died! That's why I told everyone to get out of the car!"

MCNEILL: After four hours, we arrive in the remote village of Hatu-lia and the crowds have gathered for Dr Aida.

DR AIDA GONCALVES: [weighing a baby] "How old is the baby?" 7.2 kilos.

MCNEILL: She understands these women and the difficulties they face living out here. Dr Aida grew up just a few villages away.

DR DAN MURPHY: "Those are her people. She's going to try to do something for them and she was lucky enough to be able to go for five years to get medical education in the US and come back and not lose sight of where she came from and go back to those villages".

MCNEILL: If there was a doctor like Aida around when she was young, her family might not have lost three sons to preventable illness.

DR AIDA GONCALVES: "Two of my brothers they died when one was a year and a half, the other one was two. Both of them died of diarrhoea - something in your country it's... diarrhoea don't, don't kill - yeah, doesn't kill people. But here in Timor it kills a lot of people especially babies and you know we live so far away from the hospital and you know, they had diarrhoea and my mother did not know what to do, so you know, they died of dehydration".

MCNEILL: Aida's other brother died of an asthma attack at 17.

DR AIDA GONCALVES: [to a village woman] "Did you deliver the baby at your house?"

MCNEILL: Every second day a woman in East Timor dies in childbirth - one of the highest maternal death rates in Asia.

DR AIDA GONCALVES: "They live so far away from the hospital and you know imagine you have to walk, you know you have contractions, you know you're in labour pain and you have to walk all the way from where you live, to the hospital. From here to the hospital it's about 45 kilometres so yeah a lot of women they choose to have the baby at home because of that - the distance from their homes to the hospital".

MCNEILL: In Melbourne, preparations are under way for the operation to repair Tomas Pinto's rapidly narrowing heart valve.

MELBOURNE DOCTOR: "We're hopeful that we will get a good result so that you'll be a lot better and you'll be able to go back to teaching with a lot more energy".

TOMAS PINTO: "I trust you".

MCNEILL: Tomas' rheumatic heart valve disease is rarely seen in Australia so this procedure isn't so common.Tomas' surgeon inserts a tiny balloon that will inflate and widen the valve that's been restricting blood flow.If all goes according to plan - and doctors are confident it will - then Tomas' heart will function normally. He should be able to breathe much easier and look forward to a longer life. Of course Tomas Pinto is just one example of a terrible illness that could be simply solved by expertise and resources.

DR DAN MURPHY: "Yeah. Which has pretty good treatment but it would include radiation and chemotherapy. We don't have either one. In a developed country he'd have a pretty decent chance. It's another tragedy right here of a young kid".

"We cannot deal with almost any kind of cancer very well at all".

MCNEILL: Sergio's baby sister is a patient in the malnutrition ward. He's the second oldest of five kids.

SERGIO'S MOTHER: "He's very cheeky. He and his friends come home from school and play and eat together. He really is cheeky. And then, one day, he came home with a bleeding nose".

MCNEILL: Sergio is in year three but he's stopped going to school.

SERGIO: "I used to be good at soccer, but now I'm too sick. All I can do is sit or lie down as I get sicker and sicker".

MCNEILL: In Australia chances are that Sergio's cancer might have been picked up much earlier, treated and beaten".

DR DAN MURPHY: "The surgery is not good enough, we don't have the chemotherapy, we don't have the laboratory back up that you would need to run chemotherapy programs. We don't have radiation. So when you have cancer, it's very serious. You're going to probably succumb to that problem".

MCNEILL: East Timor doesn't have a dedicated palliative care program. Morphine is in short supply and rarely used.

DR DAN MURPHY: [to Jekka, a young boy] "How are you? Are you a little better?"

MCNEILL: In a ward on the other side of the clinic, 11 year old heart patient Jekka Pereira has just received good news. An Australian cardiologist is coming to Dili in a few weeks to do an ECHO on his heart, a diagnostic test not normally available here.

"What kind of quality of life does Jekka have at the moment?"

DR DAN MURPHY: "He's limited in what he can do because he gets out of breath and you can see he's frail. He can't climb up and get a coconut. He can't play like other kids do".

MCNEILL: Once his exact condition is known, he's eligible to be the next patient heading overseas for lifesaving surgery. Jekka and his mum are even getting passport photos in the hope it will happen soon.

Tomas is providing plenty of inspiration for patients like Jekka. Just days after his surgery, he's the East Timor Heart Fund's guest of honour at the city's half marathon. He won't be running, but his presence will put a spring in the step of many of the participants here.

TOMAS PINTO: "I came here today to see how I'd go - and I felt the difference. I went up the stairs and it was fine - not like before".

DR DAN MURPHY: "I still feel like healthcare should be equally provided for everyone. I do not think we should accept in any way that rich people get one standard and poor people get another standard - and if you're born here you don't get it, if you're born there you get everything".